Archived: Ley Hill Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ley Hill Surgery on 18 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, and well-led services. We found the practice to be outstanding for providing responsive services. We also inspected the quality of care for six population groups these are, people with long term conditions, families, children and young people, working age people, older people, people in vulnerable groups and people experiencing poor mental health. We rated the care provided to these population groups as good.

Our key findings across all the areas we inspected were as follows

• There were systems in place to ensure patients received a safe service. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, reviewed and addressed. Risks to patients were assessed and well managed, with the exception of those relating to recruitment procedures which should be improved.

• There were effective arrangements in place to identify, review and monitor patients with long term conditions. Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Patients said they were treated with dignity and respect and they were involved in their care and decisions about their treatment. The practice demonstrated a caring and compassionate approach to end of life care and bereavement support.

• The practice was responsive to the needs of the practice population. The practice proactively engaged with patients in the local community and had initiated positive service improvements for its patients that were above its contractual obligations.

• There was strong and visible clinical leadership with defined roles and responsibilities and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice including:

• The practice demonstrated a caring and compassionate approach to end of life care and bereavement support. The practice had developed a ‘Bereavement Protocol’ this enabled the practice to take extra steps to communicate bereavements across departments, services and wider organisations and reduced the risk of inappropriate communications being sent avoiding unnecessary distress to family members and carers. The practice undertook reflection of the end of life care provided to patients and learning was shared with other practices. An audit was completed to ensure patients records clearly recorded their end of life wishes such as where the person would prefer to die.

• There was evidence that the practice was innovative and took a lead role in developing and improving primary care services for the local population. This included an innovative project to reduce unplanned hospital admissions in the elderly as part of the Clinical Commissioning Groups (CCG) ‘Aspiring to Clinical Excellence (ACE) Pioneers’ programme. The aim was to integrate general practice, community care with hospital care.

• The practice offered a range of in house services such as anti-coagulation services, physiotherapy and a cardiology outreach clinic. This enabled patients to be assessed and reviewed locally without the need to travel to the hospital. One patient commented on how effective this had been for their family member as the nearest hospital was some distance from their home.

• The practice had started a new system where the purpose of a medication was specified on the prescription to ensure patients were given all the relevant information they required.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Develop a system to ensure a clear audit trail for stock medicines in use.

• Ensure outstanding actions from completed infection prevention and control audits are acted on.

• Ensure robust recruitment procedures that demonstrate checks required by current legislation have been completed.

• Update the fire risk assessment and ensure risks associated with the general environment such as the control of substances hazardous to health (COSHH) are assessed and managed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice